The areas where the provider should make improvements are:

• Keep under review, improve and audit the workflow criteria protocol for correspondence.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information

We carried out an announced comprehensive inspection at Buxted Medical Centre on 10 February 2015. The overall rating for the practice was good but was rated as requires improvement in the safe domain. Following this we undertook a desktop review in 1 July 2016 to confirm that the provider now met all the regulatory requirements. On this occasion the practice was found to be good overall and in all domains. The full comprehensive report on the February 2015 inspection and the July 2016 desktop review can be found by selecting the ‘all reports’ link for Buxted Medical Centre on our website at www.cqc.org.uk.

This inspection was an unannounced focused inspection carried out on 7 March 2018 in response to information we had received in respect of procedures relating to the timely review and response of clinicians to test results and to correspondence received by the practice. The information alleged that a large backlog of both test results and letters had built up in the past. We carried out an unannounced focused inspection to ensure that systems currently in place to deal with test results and correspondence were working in a way that kept patients safe and were being employed in a timely manner. This report covers our findings in relation to those questions.

Our key findings were as follows:

• Test results and correspondence received electronically were managed appropriately and within expected time frames that kept patients safe.

• There were systems in place which allowed designated staff to identify urgent paper correspondence and forward it to a clinician for action. However we identified an instance when this had failed to work correctly.

• There was a backlog of approximately 25 working days of paper correspondence waiting to be scanned in to the electronic notes.

• Clinicians did not always have all the most recent information available to them at the time of a consultation.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Additionally the provider should:

• Consider reviewing their workflow systems and protocols to assess which correspondence requires review by a clinician and the time frames in which that should occur.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 10 February 2015. Breaches of regulatory requirements were found during that inspection within the safe domain. Following our comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the Regulatory responsibilities in relation to the following:

• To ensure staff that undertake chaperone duties, or who have unsupervised contact with patients, are checked by the disclosure and barring service (DBS) and that the practice had a recruitment policy that reflected this need.
• To ensure that the practice had undertaken an appropriate risk assessment in regards to legionella (legionella is a germ found in the environment which can contaminate water systems in buildings) and that the practice had a policy for this risk assessment.

We undertook this desktop review on 1 July 2016 to check that the provider had followed their action plan and to confirm that they now met Regulatory requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Buxted Medical Practice on our website at www.cqc.org.uk.

This report should be read in conjunction with the last report published in May 2015. Our key findings across the area we reviewed were as follows:-

• We saw that there was a robust recruitment policy in place in place to ensure that all applicants were checked by the disclosure and barring service (DBS).
• We noted that there had been a risk assessment for legionella undertaken in July 2015 and that the practice had a policy in place to manage this risk.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Buxted Medical Centre on the 10 February 2015. The practice has an overall rating of good.

We visited the practice location at Buxted Medical Centre, Framfield Road, Buxted, Uckfield, East Sussex, TN22 5FD. Buxted Medical Centre also operates a branch surgery at East Hoathly Medical Centre, Juziers Drive, East Hoathly, BN8 6AE. We did not visit the branch surgery as part of our inspection.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It required improvement for providing safe services. It was also good for providing services for people with long-term conditions, older people, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Buxted Medical Centre provides primary medical services. At the time of our inspection there were approximately 10,200 patients registered at the practice with a team of five GP partners. The practice was also supported by an advanced nurse practitioner, a lead practice nurse plus four practice nurses, three healthcare assistants, a paramedic, a team of receptionists and administrative staff and a practice manager. The practice is involved in the education and training of doctors and is also able to dispense medicines to it patients.

The inspection team spoke with staff and patients and reviewed policies and procedures. The practice understood the needs of the local population and engaged effectively with other services. There was a culture of openness and transparency within the practice and staff told us they felt supported. The practice was committed to providing high quality patient care and patients told us they felt the practice was caring and responsive to their needs.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice was a training practice and there was a culture of continuous development
• The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
• The practice recognised the needs of its older population and had systems in place to support patients through care plans, hospital avoidance schemes and providing extra support for those patients with dementia.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that all recruitment checks are carried out and recorded as part of the staff recruitment process, including criminal record checks via the Disclosure and Barring Service (DBS) for staff who have chaperone duties, and that the recruitment policy reflects accurately the procedures necessary.
• Ensure the practice carries out a risk assessment for legionella and has a corresponding policy.

In addition the provider should:

• Ensure that patient information is clearly displayed for requesting chaperones
• Ensure that patient information is clearly displayed in relation to the complaints system and contains information of other organisations that can support a complainant.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice